Suggest treatment for chronic cough and pneumonia

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Posted on Wed, 1 Apr 2015 in Lung and Chest disorders
Question: Hello,
My mom (58 years old, who lives in XXXXXXX India) has had chronic cough for a few months now. Earlier she frequently got cough and cold, and also breathlessness. In March 2014 she was diagnosed with right middle lobe collapse and underwent a course of steroids and nebulization for a couple of months. Last year in November she started feeling a lot of fatigue and breathlessness. Her blood oxygen level had come down to 80% and she got diagnosed with pneumonia leading to right middle lobe collapse again. She was admitted to a hospital and got treated for bacterial pneumonia (Klebsiella). She finally had to get a bronchoscopy done to remove a lot of phlegm from her lungs and then she started making a recovery once she was discharged in early December 2014. In mid January 2015 her sputum culture for TB (done on the phlegm extracted during bronchoscopy) came out negative. About 3 weeks ago she started getting a fever of 99-100 F. Then 2 weeks ago she started getting chills and a fever (up to 103 F) every night (11 pm - 6am). For a few days in between, the fever was accompanied by shivering. A chest CT scan on March 4 showed something in her lung. She was started on a 5 day course of Claribid 250 on March 5. Before that she had Deriphyllin and an anti-allergic for 10 days, along with duolin and budecort nebulization. She was started on Augmentin and Azee (Azithromycin) on March 10. Then 4 days ago her fever spiked at 105.6 F. 3 days ago she had a fever of 103.6 that refused to subside for 5 hours, in spite of a couple of paracetamols. A malaria test came out negative. 2 days ago one of the doctors diagnosed it as TB. However, another doctor suggested starting on Malaria medicine to rule it out. She has taken Malaria medication (Chloroquinol) for the past 2 days (while continuing Augmentin) and is much better now. She is still getting a fever in the morning, but its much lower (100.6 F) and for a much shorter duration. Do you think we should start her on TB medication as well, or else, what would you suggest?
Thanks! XXXXXXX
PS: I can provide any of the required reports (CT scans etc).
doctor
Answered by Dr. Kaushal Bhavsar 57 minutes later
Brief Answer:
Tuberculosis is less likely.

Detailed Answer:
Hello dear, thanks for your question on HCM.
I can understand your mother's situation and problem.
Since her XXXXXXX ( Bronchoalveolar lavage ) TB culture is negative, tuberculosis is less likely the cause.
In my opinion she is having recurrent bacterial pneumonia.
So better to get done sputum culture and sensitivity to isolate the causative organism and guiding appropriate antibiotic treatment.
By her history and symptoms, I think she is having chronic bronchitis also. And these patients tend to have recurrent respiratory infections due to poor lung defence.
So in my opinion she is having recurrent bacterial pneumonia other than tuberculosis.
So at present no need to start anti tb drugs.
Get done sputum culture and sensitivity first. Also get done PFT ( pulmonary function test ) to rule out chronic bronchitis.
Malaria can be a chance finding.
Please send me CT thorax and x ray images.
Hope I have solved your query.
I will be happy to help you further.
Wishing good health to your mother. Thanks.
Above answer was peer-reviewed by : Dr. Chakravarthy Mazumdar
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Answered by
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Dr. Kaushal Bhavsar

Pulmonologist

Practicing since :2008

Answered : 14621 Questions

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